At some point in the not-so-distant future, the day will come when you will don the robes of graduation and be granted the M.D. and Ph.D. degrees. What do you do afterward? Are you headed toward science, medicine, teaching, administration, or some combination? What are some of the chosen career paths of former students? The simple answer is that you can really do almost anything you want—within limits of course. Careers range from strictly basic science research to sole clinical practice, from academia to private industry or consulting. The degrees will make you highly marketable—your goals and ambitions will determine your career pathway.
The vast majority of M.D./Ph.D. program graduates (around 90% from most programs) pursue residencies in a medical specialty. In order to be licensed as a physician in the United States, you must complete residency and pass the appropriate medical board exam. Most commonly, the chosen fields are in some way conducive to the research interests of the student. Many residency programs provide time for residents to conduct research and some combine the medical residency with postdoctoral fellowship laboratory experience. Graduates with the M.D. and Ph.D. degrees comprise a relatively small group of highly trained medical scientists, with the potential to contribute to both the medical care and scientific investigation of academic medical centers. Consequently, M.D./Ph.D.’s have been extremely successful in obtaining some of the top residencies in the nation.
Alternatively, some graduates forgo clinical medicine and choose to focus solely on research by pursuing a postdoctoral fellowship. While people who opt for this pathway cannot practice medicine, they can enter the research world earlier in either academia or private industry. These graduates typically complete one or more fellowships before starting up their own laboratories. Occasionally, individuals are able to jump directly into academic or industrial careers without the postdoctoral work. Either way, building a scientific career is the prime goal.
An M.D./Ph.D. who finishes residency and ends up in the academic arena can combine various interests into a career, including medical practice, laboratory research, teaching, and administration. For example, Jeremy’s former research advisor at UCLA combines each of these elements into his career. He sees patients during a half-day weekly specialty clinic, is an attending on the wards a month per year, runs a large laboratory that conducts both disease-oriented and basic biological research, writes grants and papers to secure funding and publish laboratory results, teaches portions of medical and graduate classes, attends several seminars and conferences per year, to stay current with latest trends and fulfill continuing medical education requirements, and still manages to spend time with his wife and children. Certainly, this juggling act is not easy and requires an uncanny ability to multitask. This sort of career requires a division of time and labor that not all are willing to handle. However, an academic career offers a relatively large degree of freedom to explore new ideas and innovations. Laboratory space is provided by the university in exchange for scientific productivity. The hospital provides a base for patient care that can support one’s medical interests. In essence, the academic medical center provides an excellent forum for the blending of medicine and science into a career.
Consider the following flowchart that outlines some possible M.D./Ph.D. career pathways:
CAREER PATHWAYS OF M.D./PH.D. GRADUATES
Standard Academic Pathway (~90% of graduates):
M.D./Ph.D. -> Residency ->Postdoctoral Fellowship -> Academic/Administrative Appointment
Non-Academic Career Pathways:
Medicine: M.D./Ph.D. ->Residency ->Private/Group Practice/HMO/PPO
Research: M.D./Ph.D. ->Postdoctoral Fellowship ->Industry
These are “standard” pathways, but are by no means the only ones available. The bottom line is that having both degrees offers you a large degree of flexibility in shaping your career. Recently, academic medical centers have applied pressure to increase the clinical responsibilities of physician-scientists (at the cost of less research) due to rising medical costs and decreasing reimbursement from insurance companies and health maintenance organizations. Despite this pressure, M.D./Ph.D.s typically are able to negotiate a specified percentage of protected time for research.
M.D./Ph.D.’s have been among the most successful groups at obtaining top academic positions, securing NIH research funding, publishing articles in high-impact scientific and clinical journals, and other measures of career success. A detailed study entitled “The Careers and Professional Activities of Graduates of the NIGMS Medical Scientist Training Program” conducted by the NIH demonstrates the success of the M.D./Ph.D. program (see the following link for more details: http://www.nigms.nih.gov/news/reports/mstpstudy/mstpstudy.html).
There will always be those who doubt the value of the extra years of education and training. Your challenge will be to act as a bridge between the often divergent worlds of medicine and science. Trained to tackle complex problems, you will be uniquely qualified to communicate effectively with both clinicians and researchers to translate basic biological and technical advances into breakthrough medical treatments and enhanced patient care. The road ahead will not be easy, but with dedication and an everlasting love for both science and medicine, you will ultimately find reward in your chosen profession.